Midterm Theory Review

Question 1

Understand the aims of passive relaxed ROM as a treatment modality.

Answer 1

Help improve ROM, Reduce pain, Improve joint health by increasing the synovial fluid. By moving the join through ROM it can help MAINTAIN PROPRIOCEPTION.

Question 2

How many boney partners are moving when mobilizing a joint?

Answer 2

One and the other is stabilized

Question 3

When you are assessing a joint using joint mobilization, what is the appropriate grade to use before going to grade 3 or 4?

Answer 3

Grade 2! Grade 1 is just a distraction.

Question 4

Muscle setting is what type of contraction?

Answer 4

Isometric

Question 5

Understand the aims of active free ROM as a treatment modality

Answer 5

• Increase and maintain ROM, maintain and improve muscle health.
• Maintain circulation and lymph flow, and decrease muscle atrophy

Question 6

Contraindications to stretching.

Answer 6

• Don’t stretch a hypermobile joint
• Don’t stretch a cold muscle
• Don’t stretch when there are boney blocks present, if there’s inflammation don’t stretch, only stretch in the pain free range. ABSOLUE IS A FRACTURE

Question 7

The common goals and aims between passive relaxed and active free.

Answer 7

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Question 8

Know the different types on contractures

Answer 8

1) Myostatic: short musculotendinous unit, no specific muscle pathology, resolved with stretching exercise
2) Pseudomyostatic: due to hypertonicity, spasticity, or rigidity from a CNS lesion, inhibition techniques may relax the hypertonicities or spasm
3) Fibrotic and irreversible contracture: fibrous changes in CT causing them to adhere/stick together, stretching can increase ROM but usually not to optimal length, time dependent outcome, the longer the fibrotic tissue is in place the more irreversible the loss of ROM
4) Arthrogenic and periarticular contractures: due to intra-articular joint pathologies: adhesions, synovial proliferation, irregular articular cartilage, osteophytes. “periarticular” refers to a shortening/shifting of CT that crosses a joint.

Question 9

Muscle spindle and sarcomere! Components and purpose.

Answer 9

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Question 10

If someone has a muscle spasm you use which technique to trick the muscle into relaxing.

Answer 10

agonist contraction

Question 11

Define Musclar Power

Answer 11

Strength and speed of movement. Defined as the work (Force X Distance) produced by a muscle per unit of time (Force X Distance/Time) “the rate of performing work” Two aspects of power: anaerobic power work produced over a very brief period of time single burst of high intensity activity. aerobic power work produced over an extended period of time repetitive burst of less intense activity.

Question 12

Define Endurance

Answer 12

Ability to perform low intensity repetitive or sustained activities over a prolonged period of time. Two types of Endurance: Cardiovascular endurance: Total body endurance. Repetitive dynamic motor activities like walking/cycling Muscle endurance: Local endurance, The ability of a muscle to contract repeatedly against an external load, generate and sustain tension, and resist fatigue over an extended period of time. strength and endurance are elements of muscle performance i.e. a person who is strong will have no difficulty lifting a 10 kg object several times but they may not have the endurance (upper/lower extremity muscles and stabilizing muscles) to lift 10 kg objects several hundred times throughout the day

Question 13

Define Strength Formula

Answer 13

Ability of contractile tissue to produce tension. The greatest measurable force exerted by a muscle or muscle group to overcome resistance during a single maximal effort

Question 14

Know contraindications to joint mobilizations and modifications.

Answer 14

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Question 15

Understand the aims for joint mobilizations

Answer 15

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Question 16

The reversibility principle is “use it or lose it”

Answer 16

Increase in strength or endurance are transient unless training induced improvements are regularly used for functional activities or the person is involved in a maintenance program of exercise “Use it or lose it.

Question 17

Define The Stress-Strain curve

Answer 17

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Question 18

What does Elies (Ilys) test, test for?

Answer 18

Tests for contracture of rectus femoris.

Question 19

If there is pain within isometric what does it mean?

Answer 19

You cannot do isotonic

Question 20

What helps with prevention DOMS?

Answer 20

Warm up and cool down with low intensity.

Question 21

What is the difference between open and closed chain exercise?

Answer 21

1) Open Chain Exercise Non weight bearing position/exercise. Distal segment (hand/foot) moves freely during exercise. Most effective in isolating or training individual muscles/groups. Open chain tend to allow more control and are probably safer in the early phase of rehabilitation
2) Closed chain Exercise. Weight bearing position assumed and the body moves over a fixed distal segment. Tend to have more substitute motions. Closed chain increase joint congruency/approximation which increases stability. Less joint shear forces, results in less friction/wear and tear. Closed chains tend to provide greater proprioceptive/ kinesthetic feedback. Best choice for balance or postural control

Question 22

Understand what the synergists are for certain muscles.

Answer 22

EX: sartorius is a synergist to what? (does abduction, external rotation and flexion.) anything that does flexion or the other actions.

EX: tibialis anterior does dorsiflexion, what’s its synergist? Proneals longus and brevis. Tibialis post does eversion without dorsiflexion

EX: Deltoid? Supraspinatus.

Question 23

List the appropriate grades for peripheral joint mobilizations (PJM) for both Oscillation and Sustained. What are each grade used for?

Answer 23

1) Oscillation Techniques: Grade 1: Small-amplitude rhythmic oscillations are performed at the beginning of the range (quick vibration) Grade 2: Large-amplitude rhythmic oscillations are performed within the range, not reaching the limit (slow 2-3/second for 1 to 2 minutes) Grade 3: Large-amplitude rhythmic oscillations are performed up to the limit of the available motion and are stressed into the tissue resistance (slow 2-3/second for 1 to 2 minutes) Grade 4: Small-amplitude rhythmic oscillations are performed at the limit of the available motion and stressed into the tissue resistance (quick vibration)
2) Indication for Oscillation: Grade 1 and 2 are primarily used for treating joints limited by pain or muscle guarding. The oscillations may have an inhibitory effect on the perception of painful stimuli by repetitively stimulating mechanoreceptors that block nociceptive pathways at the spinal cord or brain stem. These non-stretch motions help move synovial fluid to improve nutrition to the cartilage. Grade 3 and 4 are primarily used as stretching maneuvers
3) Sustained Techniques: Grade 1 (loosen): Small-amplitude distraction is applied where no stress is placed on the capsule. It equalizes pressure being placed on the joint. (Apply for 7-10 sec with few sec of rest several cycles) Grade 2 (tighten): Enough distraction or glide is applied to tighten the tissue around the joint (AKA taking up the slack) Grade 3 (stretch): A distraction or glide is applied with an amplitude large enough to place stretch on the joint capsule and surrounding periarticular structures. (Apply a 6 second minimum hold, release to grade 1 or 2, then repeat in 3-4 second intervals.
4) Indications for Distraction Grade 1: is used with all gliding motion and may be used to relieve pain. Grade 2: distraction is used for initial treatment to determine how sensitive the joint is (assessment) and if done intermittently it is used to decrease pain as well as maintain joint play when ROM is not allowed. Grade 3: is used to stretch the joint structures thus increase joint play

Question 24

Describe which direction the head of the femur slides while performing abduction, Flexion, Extension, internal and external rotation of the hip joint

Answer 24

Abduction: Inferior
Flexion: Posterior
Extension: Anterior
Inter&Ext rot: Post&Ant

Question 25

Differentiate between the 4 AITs? Why would you use Agonist more than the other 3??

Answer 25

Agonist is good for spasm.

ADD TO THIS*

Question 26

Define the Convex / Concave rule

Answer 26

If the joint surface of the moving bone is CONCAVE the slide of the joint will be in the SAME direction as the swing of the bone. If the joint surface of the moving bone is CONVEX, the slide of the joint will be in the OPPOSITE direction as the swing of the bone.

Question 27

Differentiate between Concentric and Eccentric Contraction

Answer 27

Concentric- a form of dynamic muscle activation in which tension develops and physical shortening of the muscle occurs as an external resistance is overcome by an internal force as when lifting a weight.

Eccentric- involves dynamic muscle activation and tension production that is below the level of external resistance to that physical lengthening of the muscle occurs as it controls the load, as when lowering a weight.

Question 28

What aims of treatment are being achieved by the use of active free ROM in a healthy individual?

Answer 28

1) Maintain physiological elasticity and contractility of the participating muscles.
2) Provide sensory feedback from the contracting muscles.
3) Provide a stimulus for bone and joint tissue integrity.
4) Increase circulation and prevent thrombus formation.
5) Develop coordination and motor skills for functional activity.
6) HELPS REDUCE MM ATROPHY

Question 29

What are the aims being addressed with the use of passive relaxed ROM ?

Answer 29

Decrease complications that would occur with immobilization, such as: cartilage degeneration, adhesions & contracture formation, sluggish circulation.

Specific goals: maintain joint/connective tissue mobility, minimize the effects of the formation of contractures, maintain mechanical elasticity of muscle. Assist circulation and vascular dynamics. Enhance synovial fluid movement for cartilage nutrition. Decrease/inhibit pain. Assist with the healing process after injury or surgery. Help maintain patient awareness of movement. HELPS WITH PROPRIOCEPTION

Question 30

List some contraindications to stretching techniques

Answer 30

1) A bony block limits joint motion
2) Recent fracture and bony union is incomplete
3) Acute inflammatory or infectious process (heat & swelling) or soft tissue healing could be disrupted in the restricted tissues and surrounding region
4) Sharp acute pain with joint movement or muscle elongation
5) A hematoma or other indication of tissue trauma is observed
6) Joint hypermobility already exists
7) Shortened soft tissues provide necessary joint stability in lieu of normal structural ability or neuromuscular control
8) Shorted soft tissues enable a patient with paralysis or severe muscle weakness to perform specific functional skills otherwise not possible.

Question 31

Name the different types of contractures and the type of treatment to use for each

Answer 31

1) Myostatic: short musculotendinous unit, no specific muscle pathology
resolved with stretching exercise

2) Pseudomyostatic: due to hypertonicity, spasticity, or rigidity from a CNS lesion,
inhibition techniques may relax the hypertonicities or spasm

3) Fibrotic and irreversible contracture: fibrous changes in CT causing them to adhere/stick together.
stretching can increase ROM but usually not to optimal length, time dependant outcome, the longer the fibrotic tissue is in place the more irreversible the loss of ROM

4) Arthrogenic and periarticular contractures: due to intra-articular joint pathologies: adhesions, synovial proliferation, irregular articular cartilage, osteophytes. “periarticular” refers to a shortening/shifting of CT that crosses a joint.

Question 32

Name the sensory receptor that controls the length of a muscle vs the tension on the muscle?

Answer 32

Muscle spindles control the length of a muscle. The sarcomere controls muscle tension.

Question 33

Describe the 3 Principles related to resistance training.

Answer 33

1. Overload Principle: If muscle performance is to improve, a load that exceeds the metabolic capacity the muscle must be applied. Need to increase: intensity-resistance/weight, volume-repetitions/sets frequency. During Strength training the amount of resistance applied is progressively increased. During Endurance training the time of sustained contraction or number of repetitions is increased.
2. SAID Principle: Specific Adaptation to Imposed Demands to improve a specific muscle performance element, the resistance program should be matched to that element’s constructs. To increase muscle power the exercise program should consist of interventions that increase work demands while decreasing the time that work is accomplished. Specificity of Training: Exercises given should mimic the function you are trying to improve I.e. if endurance needs to improve (rather than strength) the intensity and volume should be geared to that purpose. Task specific training is important, try to recreate movement patterns, limb position and velocity of exercise to mimic the desired goal Transfer of Training (overflow or cross training) Effects are usually less than those achieved with specific training programs, I.e. muscle strengthening exercises can moderately improve endurance however endurance training has little or no cross training effect on strength.
3. Reversibility Principles Increase in strength or endurance are transient unless training induced improvements are regularly used for functional activities or the person is involved in a maintenance program of exercise “Use it or lose it.

Question 34

In the case of extreme weakness which ROM would you recommend to a patient for homecare, what is the goal you are trying to achieve?

Answer 34

Active free to decrease muscle atrophy.

Question 35

During an initial treatment of a client explain which joint mobilization would you apply and why.

Answer 35

Grade 2: distraction is used for initial treatment to determine how sensitive the joint is (assessment) and if done intermittently it is used to decrease pain as well as maintain joint play when ROM is not allowed

Question 36

Explain what an accessory versus physiological movement is, give an example of each

Answer 36

1) Physiological movements Are movements the client can do voluntarily (Flexion, abduction, etc.) The term osteokinematics is used when these motions of the bones are described.
2) Accessory Movements Are movements in the joint and surrounding tissues that are necessary for normal ROM but cannot be actively performed by the client. Joint play: the motion that occurs between the joint surfaces. The “give’ in the joint capsule. These include distraction, slide, rolling, compression, spinning (all termed as arthrokinematic) Component motion – motions that accompany active motion but are not under voluntary control. An example of this includes upward rotation of the scapula with flexion of the shoulder.

Question 37

Describe DOMS and what can we suggest for a client to do to prevent DOMS

Answer 37

Low intensity warm up and cool down.

Question 38

-Define the Roll vs the Slide of a joint. Give an example of each.

Answer 38

1) Roll: Occurs on incongruent (unequal) surfaces. New points on one surface meet new points on the opposite surface. The roll is always in the same direction as the swing of the bone. In normally functioning joints, pure rolling doesn’t occur alone but in combination with slide and spinning Ex: femoral condyles rolling on tibial plateau.
2) Slide: The same point on one surface comes into contact with new points on the opposing surface. The direction in which sliding occurs depends on whether the moving surface is concave or convex. Slide opposite –convex, Slide same –if the moving surface is concave. This mechanical relationship is known as the Convex-Concave rule and is the basis for determining the direction of the mobilizing force when joint mobilizations are used

Question 39

List 3 different contraindications for Joint Mobilizations

Answer 39

Hypermobility, Joint effusion (swelling due to trauma or disease), Inflammation, Mobilizations may be used with extreme care in the following conditions if the signs and patient’s responses are favorable.

Question 40

Describe the difference in the elastic and plastic ranges during the stress strain curve

Answer 40

1) Toe Region: The area of the stress-strain curve where there is considerable deformation without the use of much force. Normal function of range of daily activities.
2) Elastic range: Strain is directly proportional to the ability of tissue to resist the force. Bringing tissue through available range. Tissue returns to its original size and shape when load is released.
3) Elastic limit: End of elastic range. Point beyond which the tissue does not return to its original shape and size.
4) Plastic range: Extends from the elastic limit to the point of rupture. Causes permanent deformation after load is released. Process may result in increased length from stretching, Individual fibers will rupture.
5) Ultimate strength: The maximum strain the tissue can sustain.
6) Region of Necking: When there is considerable weakening of the tissue & it rapidly fails.
7) Failure: Tissue ruptures and loses its integrity o
8) Structural Stiffness: Tissues with greater stiffness have a steeper slope in the elastic region of the curve, indicating that there is less elastic deformation as stress (load) increases. Ex: contractures and scar tissue have greater stiffness due to a greater degree of bonding between collagen fibers and their surrounding matrix. Tissue with less stiffness will demonstrate greater elongation than those with greater stiffness under the same external load.

Question 41

Define Creep

Answer 41

Refers to the viscosity of the tissues and is therefore time dependent. When a load is applied for an extended period of time, the tissue elongates resulting in permanent deformation. Low magnitude loads in the elastic range applied for long periods, allow time for the collagen fibers to realign and become stronger.

Question 42

Describe the difference in Stabilization and Multi-Angle Isometrics

Answer 42

Stabilization Exercise Typically consists of contractions against resistance in antigravity or weight bearing positions. Resistance is usually provided by body weight or applied manually Used to develop a submaximal but sustained level of concentration to improve postural stability or dynamic joint stability.

Multiple-angle isometrics Resistance is applied at multiple joint positions within the available ROM. Used when the goal of exercise is to improve strength throughout the ROM when joint motion is permissible but dynamic resistance exercise is painful or inadvisable.

Question 43

Pathological fractures are a precaution for Remedial Exercises. What bones do these commonly occur in?

Answer 43

Vertebrae, Femurs, Hips, Wrists

Question 44

Define Endurance ?

Answer 44

Ability to perform low intensity repetitive or sustained activities over a prolonged period of time

Two types of Endurance:
Cardiovascular endurance: Total body endurance Repetitive dynamic motor activities like walking/cycling
Muscle endurance: Local endurance The ability of a muscle to contract repeatedly against an external load, generate and sustain tension, and resist fatigue over an extended period of time.

Question 45

Define Flexibility:

Answer 45

The ability of structures to be moved freely, without restriction.
Can be used interchangeably with mobility

Question 46

What direction will the slide occur if the surface of the moving bone is concave? Convex?

Answer 46

If the joint surface of the moving bone is CONCAVE the slide of the joint will be in the SAME direction as the swing of the bone.

If the joint surface of the moving bone is CONVEX, the slide of the joint will be in the OPPOSITE direction as the swing of the bone.

Question 47

Define Concentric

Answer 47

Form of dynamic muscle activation in which tension develops and physical shortening of the muscle occurs as an external resistance is overcome by an internal force as when lifting a weight.

Question 48

Define Eccentric

Answer 48

Involves dynamic muscle activation and tension production that is below the level of external resistance to that physical lengthening of the muscle occurs as it controls the load, as when lowering a weight.

Question 49

Which grade of joint mobilizations would you perform for a client who has a decrease in GH flexion?

Answer 49

Posterior glide

Expand answer what grade?

Question 50

If a client presents signs and symptoms of inflammation which grade of joint mobilizations would be safe and effective?

Answer 50

Grades 1
Grade 2 is for assessment
Inflammation is CI??